Surgical-site infection following lymph node excision indicates susceptibility for lymphedema: A retrospective cohort study of malignant melanoma patients

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 71; no. 4; pp. 590 - 596
• Main Authors: Jørgensen, Mads Gustaf, Toyserkani, Navid Mohamadpour, Thomsen, Jørn Bo, Sørensen, Jens Ahm
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.04.2018
• Subjects: Axilla; Female; Groin; Humans; Lymphadenectomy; Lymphatic Metastasis; Lymphedema - etiology; Male; Melanoma - surgery; Melanoma, Cutaneous Malignant; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; Sentinel Lymph Node Biopsy; Seroma; Skin Neoplasms - surgery; Surgical wound infection; Surgical Wound Infection - complications; Surgical wound infection; Lymphadenectomy; Seroma; Risk factors
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2017.11.026

Cancer-related lymphedema is a common complication following lymph node excision. Prevention of lymphedema is essential, as treatment options are limited. Known risk factors are firmly anchored to the cancer treatment itself; however potentially preventable factors such as seroma and surgical-site infection (SSI) have yet to be asserted. All malignant melanoma patients treated with sentinel lymph node biopsy (SNB) and/or complete lymph node dissection (CLND) in the axilla or groin between January 2008 and December 2014 were retrospectively identified. Identified patients were followed until March 2017 for the incidence of lymphedema. We identified 70 cases of extremity lymphedema following 640 SNB/CLND. SSI was an independent risk factor for developing lymphedema (HR 8.46, 95%CI 4.37–16.36, p < 0.001), whilst seroma was an independent risk factor for developing SSI (OR 6.92, 95%CI 4.11–12.54, p < 0.001). In addition, the risk of lymphedema was significantly larger following inguinal incisions compared to axillary incisions (HR 2.49, 95%CI 1.36–4.55, p < 0.05). SSI was the greatest independent risk factor for developing lymphedema. Additionally, patients' that developed postoperative seroma were at an increased risk of also developing SSI. Future studies should examine if lymphedema can be prevented, by reducing seroma and SSI.